Client-Assisted Triage Improved FLOW IN A Busy Public URBAN STD Clinic

Background: Most public STD clinics provide services to clients regardless their ability to pay and a significant number of clients also have no health care insurance. With a limited budget and increased demands for services, alternative strategies to improve the flow of clients are constantly sought.

Objectives: To evaluate the results of implementation an innovative client-assisted triage system in a busy public urban STD clinic

Methods: In April 2008 we implemented an innovative client-assisted triage system that consisted in the assignment of clients to personnel according to the level of care needed by the registration clerks.  Clerks assigned clients to medical assistants, registered nurses (RN), or “advanced practitioners” (MD, ARNP, and PA) based an algorithm using the answers given by clients to the questionnaire. Monthly and annual census reports of the two years previous to the implementation of the new system were compared with the correspondent reports after the change, matched by month. The clinician (RN, MD, ARNP, PA) productivity was calculated as the rate of the total number of clients seen per period over the total number of full time employees (40 hours/week = 1 FTE).

Results: Clinician’s FTE decreased from 9.2 in 2006 to 7.8 in 2007 and to 5.5 in 2008, but the clinician’s productivity (April to December) increased from 137 in 2006 to 148 in 2007 and to 218 in 2008. Using the T test, there was a statistical significant difference between clinicians’ productivity in the year 2008 compared to 2006 and 2007. There was not such a difference between years 2006 and 2007.

Conclusions: Client-assisted triage improved clinic flow in this clinic and resulted in statistically significant increase in provider productivity.

Implications for Programs, Policy, and/or Research: Innovative strategies to increase clinicians’ productivity should be developed and tested to improve clinic flow in STD clinics.